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Hand Sanitizer: Keeping Little Hands Clean and Safe

Door knobs. Stair rails. Elevator buttons. Just the thought of touching any of those during cold and flu hand_sanitizerseason may send you running for the nearest bottle of hand sanitizer. Hand sanitizer is a convenient way to keep your hands clean and germ-free, but parents should be aware of the potential harm it can cause.

“There are times when you don’t have access to good old-fashioned soap and water to wash your hands,” said Ann Slattery, managing director of the Regional Poison Control Center at Children’s of Alabama. “Using hand sanitizer is an easy way to stay healthy when you’re on the go, but it’s not without its own inherent danger because it contains alcohol.”

Hand sanitizers contain 40 to 95 percent alcohol, and many formulas contain a stronger alcohol concentration than most hard liquors. Just 1 ounce of hand sanitizer – most are greater than 60 percent – has the same alcohol content as a 12 ounce can of beer. Therefore, accidental ingestion or intentional misuse of hand sanitizer is cause for concern.

“From a young child’s perspective, hand sanitizer may smell good, and it’s usually in brightly colored, glittery bottles,” Slattery said. “With older children, there are reports of them daring others to drink it.”

The number of reported cases of hand sanitizer exposure in Alabama has grown since 2011. That year, there were 159 calls to the Regional Poison Control Center involving hand sanitizer. Through October 2015, Slattery said there have been about 300 calls involving hand sanitizer, already surpassing the total 269 calls involving hand sanitizer in all of 2014. Nationally, there were nearly 15,000 reported exposure cases through August 2015.

To prevent potentially harmful exposure to hand sanitizer:

  • Keep hand sanitizer well out of reach of children at all times.
  • Children should use hand sanitizer only with adult supervision.
  • Apply a dime-sized amount of sanitizer to dry hands, and rub together until completely dry.

If you suspect your child may have ingested any amount of hand sanitizer, Slattery encourages parents to call Poison Control at 1-800-222-1222 immediately. The signs won’t always be as obvious as an empty bottle lying around. “When in doubt, check it out,” she said.

Some potential symptoms of harmful exposure to hand sanitizer include:

  • Drowsiness
  • Stumbling
  • Falling

Some delayed symptoms could include a drop in blood sugar and a drop in body temperature.

The Regional Poison Control Center’s hotline is available 24 hours a day, 7 days a week. Established in 1958, The Regional Poison Control Center at Children’s of Alabama more than 50,000 poison calls annually, plus more than 60,000 follow-up calls. For more information, visit


Pinkeye is the most common eye problem children can have, but it can be alarming when it happens to your child. Pinkeye, or conjunctivitis, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids.

Dr. Christina Fettig, a pediatrician with Mayfair Medical Group in Homewood, says the most common symptoms of pinkeye include:


  • Reddening of the eye
  • Discomfort
  • Tearing or draining from the eye
  • Feeling like there’s sand in the eye

You’ve probably heard that pinkeye is highly contagious. Dr. Fettig explains there are actuallyfour different types of pinkeye, two that are contagious and two that are not.

Contagious Forms of Pinkeye

  • Viral (often accompanied by the common cold, usually goes away on its own)
  • Bacterial (very common, can be treated with drops)

Non Contagious Forms of Pinkeye

  • Allergy based (more prone in children with allergies, especially seasonal allergies)
  • Irritant caused (swimming)

Because there are multiple types of pinkeye, it’s especially important to see your child’s pediatrician early to identify which type it is and the course of treatment.

“It is important, especially with bacterial pinkeye,” Fettig said. “If started early enough eye drops can decrease the duration of symptoms.”

In addition, doctors usually recommend keeping kids who have been diagnosed with contagious conjunctivitis out of school or daycare until the symptoms have been resolved.


Simple hand washing is the number one way to prevent pinkeye. Children should be taught to wash their hands well and frequently with warm water and soap. Parents should remember to wash their own hands thoroughly after touching their child’s eyes, particularly after treating their infected child with eye drops.

While contagious pinkeye may be uncomfortable and inconvenient, there is good news. Pinkeye caused by a virus will usually resolve on its own. Bacterial pinkeye is easily treatable. And in most cases, conjunctivitis causes no long term eye or vision damage.


Fall is a time of year when kids often pick up colds and other viruses. Unfortunately they’re also more at risk of getting something more serious, meningitis.

Meningitis is a disease involving inflammation of the meninges, the membranes that cover the brain and spinal cord.

There are two types of meningitis: viral and bacterial.

“The prognosis for viral meningitis is very good,” according to Dr. Mark Baker, a physician in the Emergency Department at Children’s of Alabama. “It’s relatively common and usually goes away in about a week. The prognosis for bacterial meningitis depends on how quickly you get treatment.

Viral meningitis

As Dr. Baker indicated, viral meningitis is the most common form. It’s usually less serious than bacterial meningitis. It’s caused by many different types of viruses, including those that infect the skin, urinary tract, or digestive and respiratory systems.

Children with viral meningitis may present a lot of flu like symptoms.

  • These include:
  • fever
  • headache
  • sensitivity to light
  • fatigue
  • fussiness
  • nausea
  • neck stiffness
  • vomiting

To identify meningitis, doctors may do a spinal tap (lumbar puncture) to get a sample of the cerebrospinal fluid for testing. Most people recover on their own within 7-10 days.

Bacterial meningitis

Bacterial meningitis is rare, but is usually more serious and can be life threatening if not treated immediately.

Bacterial meningitis is caused by different types of bacteria. Bacteria that infect the skin, urinary tract, gastrointestinal and respiratory system can spread via the bloodstream to the meninges.

Sometimes bacteria may spread from severe head trauma or a severe local infection, such as a serious ear or nasal infection.

A person with bacterial meningitis may have:

  • fever
  • headache
  • stiff neck
  • sensitivity to light
  • extreme tiredness
  • irritability
  • nausea
  • vomiting

If untreated, bacterial meningitis can lead to seizures, coma and even death.

For this reason Baker said it’s important to see your child’s physician anytime they are ill and don’t seem to be acting like themselves.

“Anytime you think your child is seriously ill, or something doesn’t seem right,” he said. “It’s a good idea to have your doctor check them out or come to the emergency room and have a doctor check them. Also, if your child has had contact with someone who has meningitis, you should call your doctor to see if preventive medication is recommended.”

Treatment for bacterial meningitis includes an extended hospital stay with a strong dose of IV fluids and antibiotics.

There is encouraging news, though, in terms of prevention. Routine immunizations can go a long way toward preventing meningitis. The vaccines against Hib, measles, mumps, polio, meningococcus, and pneumococcus can protect against meningitis caused by these microorganisms.

Children’s of Alabama Expands Child Maltreatment Services

Dr. Michael A. Taylor is director of the newly created Division of Child Abuse Pediatrics at Children’s of Alabama and professor of Pediatrics at the University of Alabama at Birmingham (UAB). He is board certified in general pediatrics and child abuse pediatrics. He has extensive experience in providing medical services and support to abused and neglected children.

Michael Taylor

Michael Taylor

Child maltreatment is a significant public health problem in Alabama, as it is in all states. The most recent statistics available show there were nearly 20,000 reports of child abuse or neglect during 2013 in Alabama, with about 9,000 children confirmed as victims. And that is just the tip of the iceberg, with cases often going unreported and under-reported. Studies indicate that about 1-in-8 children nationally are victims of serious abuse or neglect by the time they reach their 18th year.

Children’s of Alabama is responding to this widespread problem with the creation of a new Child Abuse Pediatrics Division. It will expand the current services provided by the Children’s Hospital Intervention and Prevention Services (CHIPS) Center.

Child maltreatment encompasses a wide variety of conditions, including physical abuse, sexual abuse, caregiver fabricated illness (previously referred to as Munchausen syndrome by proxy), neglect and psychological/emotional abuse. Thus, child abuse pediatricians must work within medical, child welfare, law enforcement and judicial systems. We are often called to testify in court.

The CHIPS Center has provided forensic medical evaluations, psychosocial assessments, play therapy, counseling, case management services, prevention education, court support and expert court testimony in cases of suspected child abuse. Drs. Melisa Peters and David Bernard have provided medical care to maltreated children at Children’s for many years through the CHIPS Center and the Emergency Department (ED); however their availability to provide care has been stretched between these two services.

The UAB Department of Pediatrics and Children’s created the new Division of Child Abuse Pediatrics along with a full-time director, a position I am honored to hold. This division will provide oversight for existing child maltreatment services being offered through Children’s and UAB. This includes The CHIPS Center, the pediatric sexual assault nurse examiner (P-SANE) program, which operates out of the ED, and other physical abuse and neglect services. Drs. Bernard and Peters have invaluable experience serving maltreated children and are both board certified in general pediatrics, child abuse pediatrics and pediatric emergency medicine. They will continue to play key roles with Dr. Bernard as the medical director for the SANE program and Dr. Peters as the medical director for The CHIPS Center.

These actions are moving Children’s to the advanced tier of services for child maltreatment. Over the next five years we will move to develop at Children’s a “Center of Excellence,” the top tier as defined by the Children’s Hospital Association (CHA). This expansion will involve an extended regional presence, larger child protection teams, an accredited fellowship, research initiatives and increased family intervention and prevention services.

I have a special affection for Children’s, having served my pediatric residency here and serving as a long-time pediatrician at the University Medical Center in Tuscaloosa. And I am passionate about providing medical services to our most vulnerable children.

Children’s has a Level 1 Trauma Center, a Burn Center, a large Emergency Department, a nationally known neonatal intensive care unit, pediatric cardiovascular services, the Alabama Center for Childhood Cancer and Blood Disorders and many other top organizations within top organizations. Children’s is now becoming a leader in the recognition, management and prevention of child maltreatment.

Medication Safety

The difference between a tablespoon and a teaspoon is a mere 0.33 liquid ounces. That’s barely two-hundredths of a pound. Yet that minuscule amount can also be the difference between a healthy child and a terrifying trip to the emergency room.medsafety

One of the biggest dangers to children can be found in the small bottles that are supposed to make them feel better. In 2011, nearly 68,000 children in the United States were seen in emergency rooms for medicine poisoning, according to And some of those emergencies were prompted not by children getting into medicines on their own, but rather by their parents accidentally giving them the incorrect drug or dosage.

Karen Cochrane, a nurse and educator in Patient Health and Safety Information at Children’s of Alabama, says there are several simple but important steps parents should take whenever they are giving medication to their children.

“First, it’s very important to realize that children are not small adults,” Cochrane says. “Sometimes people think that medicines that are taken frequently, such as ibuprofen or acetaminophen are no big deal. But for small children, you have to be very, very careful. Because there are some medicines you shouldn’t give to children until they are a certain age or weight.”

Cochrane says parents should begin with a triple-check of the medicine itself. “Check the outside packaging to make sure it’s intact, that there are no cuts or tears,” she says. “Then when you are home, check the label on the inside package to make sure you have the right medicine. And then check the color, shape, size, smell, everything. If it doesn’t look or smell right, talk to the pharmacist.”

Other tips from the U.S. Food and Drug Administration include:

  • Do not mix two different over-the-counter medicines without knowing the active ingredient. Acetaminophen, for example, is in more than 600 medications. “So you don’t want to give something for a headache and then something for a fever and double-dose,” Cochrane says. “That’s a very easy thing to do. You want to know exactly what you’re giving, especially if you’re giving more than one. So be sure to check the active ingredients on the bottle.”
  • Use the dosing tool that comes with the medicine, and have a firm understanding of measurement sizes and abbreviations, particularly the difference between tablespoon (tbsp.) and teaspoon (tsp.), and milligram (mg.) and milliliter (mL). “A kitchen spoon isn’t going to measure out the correct amount,” Cochrane says.
  • Do not increase the dosage if the child isn’t improving, or try to catch-up if you miss a scheduled dosage time. “You don’t want to play doctor,” Cochrane says. “If one strength works a little bit, doubling it is not going to make them feel twice as good. Instead it could cause some harm. And if the child misses a dose, make sure to check with the doctor to see what to do. Never just go ahead and give another dose.”
  • Treat the medicine as medicine, and make sure children understand what they are receiving. “Never tell them that it’s candy,” Cochrane says. “There are a lot of medicines that look like candy, and they’re flavored to make it easy to take. Tell children it’s time for their medicine, and then put it away each time up and out of sight, even if you’re going to give it to them again in four hours.”
  • Communicate with your doctor and pharmacist. Let your physician know every medicine that you give your child, including vitamins and herbal supplements. Ask questions about potential side effects. Have your pharmacist mark the correct dosing amount on the syringe. “It’s OK to ask a lot of questions and double-check everything just to be sure,” Cochrane says.
  • Finally, program the number for the Regional Poison Control Center at Children’s of Alabama (800-222-1222) into your phone. “They can give you any information about medicine safety,” Cochrane says. “Hopefully you never need to call them, but if you do the number will be right there.”

Because when it comes to medication safety for children, the smallest things can make a big difference.

Hope and Cope

 Dr. Avi Madan-Swain, is an associate professor of pediatrics and director of the Hope and Cope Avi Madan-SwainPsychosocial Program in the Division of Pediatric Hematology-Oncology at Children’s of Alabama.  She has worked extensively with children diagnosed with cancer and other blood disorders and their families in both inpatient and outpatient settings. 

Most people know that the Alabama Center for Childhood Cancer and Blood Disorders at Children’s of Alabama provides cutting-edge cancer treatments. But our care goes well beyond the lifesaving surgeries, chemotherapy and radiation therapy. Since 2008, our Hope and Cope Psychosocial Program has been providing support and services from diagnosis onward using a family-centered approach, where the family and health care providers are partners working together to best meet the needs of the patient.

Our interdisciplinary Family Support team, consists of skilled and compassionate specialists, including social workers, child life specialists, pediatric psychologists, pediatric neuropsychologists, chaplains, hospital-based teachers, school liaisons, art and music therapists, as well as a rhythm drumming specialist to provide emotional, psychological and spiritual support and also assist with concrete needs. Theyfocus on identifying family strengths and resiliency factors, as well as risk factors, and provides evidence-based interventions. Some families need emotional help. Some need financial help. Some need spiritual help.

To ease the stress and distress from frequent hospitalizations or lengthy outpatient visits, the Hope and Cope Psychosocial Program offers a variety of emotional health and well-being activities including: Art/Music/Drumming and Rhythm Circle, Beads of Courage, Gardening on the Terrace, group school or bedside instruction, STAR (School/Social Transition & Re-entry), Hand in Paw Animal-Assisted Therapy, Hand of Hope Volunteers, individual therapy for patients or family members to help with specific individual challenges being faced, Parent 2 Parent Mentoring, as well as a weekly inpatient Caregiver Dinner Support Group to give families a break from hospital food. Many of these activities are made possible through partnerships with local community businesses and organizations.

Many of our diversionary activities are popular and fun. For example, our rhythm drumming attracts entire families and allows them to express themselves through music.  We plan on soon adding drama therapy, and hope to have all of our patients work together on a theatrical production describing their medical journey.

On the more practical side, our STAR initiative focuses upon the often complex educational needs of childhood cancer patients. School is one of the most important parts of a child/teen’s life. Focusing on school helps the child/teen look to the future and is a step toward returning to a more normal lifestyle. We believe that when a child/teen diagnosed with cancer or a blood disorder is medic ally able, they should return to classroom. It is important to keep children on track with their education, because it sends a strong message about our confidence in their continued growth and development. We offer group school daily in the hospital, along with bedside instruction when the child is medically unable to attend.

Our STAR team school liaisons work with education systems to help cancer survivors successfully transition back to school. The school liaisons work closely with the family and serve as a link to provide ongoing communication between the hospital and school. When the child/teen is ready to attend school regularly, the school liaisons work with the child/teen, parent and school personnel to develop an individualized school re-entry plan to ensure a smooth transition.


STAR school liaisons also teach parents how to navigate the educational system. They learn about their child’s learning difficulties that are associated with the cancer diagnosis and treatment, their child’s educational rights and how to successfully advocate on their behalf. Sometimes our school liaisons attend school meetings to help ensure that educational accommodations are included in the child’s educational program. The school liaisons advise parents on what is reasonable to expect from schools and connect them to resources that help ensure those expectations are met.

Childhood cancer survival rates have risen dramatically in recent decades, but not all children win their battle against cancer. The Hope and Cope Psychosocial Program has designed activities to assist children with a terminal diagnosis. For instance, our art therapist works with the patient and their family to create a “legacy” piece of art that serves as a remembrance after the child’s death. Additionally, we host an annual “Honoring Their Journey” memorial service for families who have lost their child to cancer or blood disorder in the past year. It is a time for families to reconnect with staff and share memories.

It’s important that parents become active participants in their child’s medical care; after all, no one knows their child better than they do! Parents are equal partners on their child’s care team, and their voices needs to be heard during family-centered rounds. Through sharing information openly and honestly, the medical team, patient and family work collaboratively to develop daily goals as well as discharge goals.  Parents need to be engaged and empowered. They need to feel comfortable asking questions and providing input during daily inpatient rounds or outpatient visits.

Childhood cancer knows no boundaries. It can strike young children and older children. It can strike the wealthy and the impoverished, black or white. Similarly, the needs of a family are boundless, too, and vary widely. Until childhood cancer is eliminated, the Hope and Cope Psychosocial Program is here to empower young people and their families to foster a sense of healing throughout the medical journey.


This time of year as the kids are going back to school, some may bring home some unwanted guests… Lice!   Lice are highly contagious and extremely common.  Six to 12 million American children get head lice very year.

The head louse is a tiny, wingless parasitic insect that lives among human hairs and feeds on tiny amounts of blood drawn from the scalp. They can spread quickly from person to person.

“Contrary to common belief, anyone can get head lice,” said Stephanie Armstrong, RN, a registered nurse at Greenvale Pediatrics-Brook Highland. “It doesn’t matter if you’re rich or poor, if you have clean hair or dirty hair– you can get lice,” she said. “Lice aren’t dangerous but they are a nuisance and can be difficult to deal with.”


Some of the symptoms of head lice include itching and scratching.  This is due to a reaction to the saliva of lice.  Parents may also notice small red bumps or sores from scratching.  And children may complain of feeling like something is moving around on or tickling their heads.

How to identify lice:

If your child is showing symptoms of head lice, they should be easy to identify.  The lice and the nits (eggs) can be seen by the naked eye.  “Usually at the nape of the neck or behind the ears there are small eggs that are attached to the hair shaft,” said Armstrong. “They may be white or yellowish brown. They look different than dandruff as dandruff flakes away pretty easily and quickly, while lice eggs are pretty hard to pull out.”


Treatment for lice is highly effective. Options include over the counter medicated shampoos as well as more natural shampoos designated for treating lice.  Armstrong says the key is to follow directions carefully to avoid recurrence.  Most treatments require a follow up application after 7 to 10 days. This is to kill any newly hatched nits.

Still, it’s important to keep in mind that lice medication is a pesticide.  Applying too much or using it too often can increase the risk of causing harm.  Always read the product label carefully and follow directions precisely.

Here are some simple ways to get rid of the lice and their eggs, and help prevent a lice re-infestation:

  • Wash all bed linens and clothing that’s been recently worn by anyone in your home who’s infested in very hot water (130°F [54.4°C]), then put them in the hot cycle of the dryer for at least 20 minutes.
  • Put anything that can’t be washed (like stuffed animals) in airtight bags for at least 3 days.
  • Vacuum carpets and any upholstered furniture (in your home or car), then throw away the vacuum cleaner bag.
  • Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and brushes in rubbing alcohol or medicated shampoo for 1 hour. You also can wash them in hot water or just throw them away.

Because lice are easily passed from person to person in the same house, bedmates and infested family members also will need treatment to prevent the lice from coming back.


While highly contagious, it’s important to remember that lice cannot jump or fly.  The only way of transmitting them is by direct contact.

Teach your children to never share combs or brushes, hats, scarves, jackets or headphones.

In addition a popular pastime of young people has become a common lice transmitter: taking selfies! Tell children to avoid any kind of head-to-head contact.

Lice can be hard to eliminate.  If after following every recommendation your child still has lice it could be because:

  • Some nits were left behind
  • Your child is still being exposed to someone with lice
  • The treatment you’re using isn’t effective

If your child still has lice two weeks after you started treatment or if your child’s scalp looks infected, call your doctor.  While lice can be a hassle and embarrassing, reassure your child that anyone could get them and that there is light at the end of the tunnel.  Be patient, follow all instructions carefully, and soon your family will be lice free.


Respiratory illnesses like asthma are the number one reason why patients come to Children’s of Alabama.  Asthma is an inflammatory lung disease that is very common in children and adults.

Having asthma causes:

  • airway muscles to tighten
  • inflammation to increase
  • swelling in the airways
  • mucus to build up

Airways become swollen, tight and narrow making it hard to breathe.

Common symptoms include:

  • coughing which is often worse at night
  • chest tightness
  • wheezing
  • coughing or difficulty breathing with exercise

In persistent asthma, children have more frequent symptoms and flare-ups.  This is caused by increased airway inflammation, swelling and narrowing that is present every day.

Children with intermittent asthma have few symptoms because they only have rare times of airway swelling and narrowing.

Janet Johnston, CRNP, is a nurse practitioner and asthma educator at Children’s of Alabama.   She said even though there’s no cure for asthma, in most cases families can learn how to make sure their child’s asthma is well controlled.

One of the most important ways to do that is to know the triggers of asthma.

Common triggers are:

  • respiratory infection
  • allergies
  • irritants such as smoke
  • exercise

Oftentimes, just avoiding the triggers can help reduce the occurrence of symptoms.

The exception is exercise. “One trigger you don’t want to avoid is exercise,” she said. “If the child’s asthma is well controlled, they shouldn’t have to avoid exercise.”

Johnston said another concern is making sure the child gets the full dose of medicine through an inhaler alone.  She recommends always using a spacer with the inhaler.

“Using a spacer ensures the proper dose of medicine is going deeply in the child’s lungs,” she said. “It’s important to get the full dose of medicine.  Otherwise, it’s like pouring half of it on the floor.”

Johnston encourages families to have an action plan to help keep their child’s asthma well controlled. The plan should include:

  • seeing the child’s health care provider regularly for asthma
  • having clear instructions about using the inhaler and any other medicine
  • know what to do when symptoms increase
  • know when to call the doctor
  • know when to seek care

Well-controlled asthma means a child is:

  • symptom-free most of the time and not needing frequent quick relief medicine
  • able to play and exercise like other children
  • sleeping through the night
  • not missing school or work due to frequent asthma fare ups


More information about managing asthma is available at

Lake Safety

Alabama is known for its beautiful lakes and enjoying them is a rite of summer.  However, before your family heads to the water, you’ll want to take these precautions to ensure your visit is enjoyable and safe.

Always Wear a Coast Guard Approved Vest

Debbie Coshatt, RN, and nurse educator in Patient Health and Safety at Children’s of Alabama reminds us the importance of being safety conscious at the lake, “Drowning is the second leading cause of death in children,” she says, “Anytime the children are outside, near water, you want to make sure they are wearing a Coast Guard approved life vest.”

Coshatt points out that pool toys like floats and rings are not Coast Guard approved and should not be used; they can give children a false sense of security.  Instead, check your child’s life vest, and be sure it says, “Coast Guard approved” on the tag.

In addition, children should never be left to swim without adult supervision.   Coshatt reminds parents that drowning is often a silent emergency, and that a child can disappear in seconds.

No Diving

Kids and adults often enjoy jumping into a lake, but this can pose a danger because lake water is dark and the floor has different depths, as well as rocks beneath the surface.

For this reason, never dive into a lake head first.  Always jump feet first, and it’s a good idea to know how deep the water is before going in.

Boat Safety

It’s important to obey the law in and around boats as well.  Alabama law states

minors under the age of 16 must wear a life jacket when on a boat.  This law went into effect in 2009 and replaces an older law that required children ages 12 and under to wear a life vest.

In addition, the law states that everyone over the age of 16 must have a life jacket readily accessible and available on any kind of vessel.

Also, make sure the engine and propeller are turned off before getting in and out of a boat. Children should not be operating a boat or Jet Ski at any time.

These other tips will help to keep your family safe on the lake this summer:

  • Don’t let kids swim without adult supervision — lakes or ponds might be shallow near the bank, but increase in depth sharply farther out from shore.
  • Ponds and lakes may hide jagged rocks, broken glass, or trash.
  • Make sure kids wear foot protection; even in the water, they should wear aqua socks or water shoes.
  • Watch out for weeds and grass that could entangle a leg or arm.
  • Most boating accidents, particularly among teens, are related to alcohol. When you and your family are boating, assign a designated driver who won’t drink. Be sure teens know about the dangers of alcohol, on and off the water.

By following these tips, you’ll ensure your trips to the lake are enjoyable and safe for your entire family.

Critical Care Medicine at Children’s

Leslie HayesDr. Leslie Hayes is a certified pediatric critical care physician at Children’s of Alabama and an associate professor of pediatrics in the Division of Pediatric Critical Care at the University of Alabama at Birmingham (UAB) where she trains medical students and doctors in pediatric critical care.

Every year, hundreds of children are admitted to critical care units at Children’s of Alabama. These patients come from within Alabama and from every surrounding state. They come because we offer them a broad variety of life-sustaining care. We see trauma victims and brain injury patients. There are post-operative surgical patients who need close monitoring. And there are premature babies. In fact, if you name a severe, life-threatening illness or condition, we’ve most likely seen it.

Dr. Sam Tilden started critical care services at Children’s in the late 1980s, and now we have one of the busiest critical care systems in the nation for children. We spend a tremendous amount of time and resources ensuring that our critically ill and injured patients are cared for by the best, fully trained health professionals using the most advanced medical technology. We have nine critical care faculty members and another six faculty members just for the cardiac ICU. We train six critical care fellows at a time.

The Children’s Pediatric Intensive Care Unit (PICU), where I spend much of my time, has 22 beds and is located on the seventh floor of the Quarterback Tower in the Benjamin Russell Hospital for Children, and has about 1,400 admissions a year. Nearly all of our critical care patients are in Benjamin Russell Hospital for Children, but the neonatology service additionally has patients at UAB’s Regional Neonatal Intensive Care Unit connected to OB/GYN services at UAB. Children’s has its own 48-bed neonatal intensive care unit, along with a 20-room cardiac intensive care unit and also a burn center that cares more than 170 patients a year. In addition, Children’s operates a 26-bed special care unit, which is a step-down unit for our ICUs.

The PICU handles the greatest variety of patients. Adult intensive care units (ICUs) tend to be subdivided into more specialized units. Our PICU takes patients needing high-level monitoring, intense observation, special procedures and numerous interventions. Patients range in age from birth through young adulthood. Nurses care for one or two patients at a time, depending upon the severity of illness. We welcome and encourage parents to stay with their children.

Education and training are constant and intense. We train fellows, pediatric medical students, nurses and other medical staff. We are dedicated to our trainees. Our aim is to develop leaders and top-notch researchers.

We are strong advocates for continuous quality improvement. We are always looking for ways to improve care. We exchange research with other pediatric hospitals to ensure that we are operating on par with our peers, and staying abreast of new techniques.

Staying on the cutting edge of medical technology is important. It makes caring for patients easier and more effective. For example, we are now using very high quality ultrasound devices while placing central lines in children. That new technology has significantly improved the safety and quality of central line placement. We also have new video devices that we use while performing intubations to place a patient on mechanical ventilation. This device helps us perform that procedure more safely while also allowing trainees to observe the process.

We try to minimize the risks of hospitalization for children by reducing the amount of time they spend in the ICU, and we are good at that. When compared to our peer ICUs across the country, we have shorter lengths of stay. Providing the most effective care in the shortest amount of time helps return children quickly to their optimal state of health.

Unfortunately, when working with critically ill or injured patients, outcomes aren’t always what we’d like. Sometimes all we can do is deliver the safest and highest quality care in the most efficient way. We have to recognize that children sometimes have an illness that we are unable to cure. At those times we have to work in a family-centered way to understand goals of care for that child and work with the family to do all that is possible.

Critical care medicine is extremely difficult work, but it is also personally rewarding.


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